AAAError Codes and Possible Resolutions

This page provides some examples of AAAError codes and possible resolutions.

AAAErrors

Payers are considered the Information Source for all Eligibility queries, and this is the standard term in the medical industry. The provider submitting an eligibility query is called the Information Receiver.

AAAErrors report on missing or invalid information from various parts of the submitted 270 Eligibility request and show possible resolutions. It is the standard error reporting system for all the Eligibility transactions. AAAErrors generate from seven different sections of eligibility queries.
Payer, Subscriber, Provider, and Dependent objects fall in the AAAError category.

AAAError CategoryDescription
Information Source levelErrors in this category indicate problems or mistakes in reaching the query's specified recipients, such as the Interchange/Clearinghouse ID (ISA06), or the payer (ISA08). The correct Interchange ID is important because the transaction you are submitting is used by both you, as the query sender and the ultimate receiver of the query, who is the payer that will verify the insurance coverage. There might be a mistake in the Payer object and the Interchange cannot locate it in the payer network.
Request ValidationReports system errors, such as more patient queries than the submitter is allowed to send; the query is being sent by a provider that is not authorized to submit requests to the Payer; the Payer is experiencing network problems or otherwise unable to receive and process the submission, and other causes.
Information ReceiverProblems are detected in the request content defining the query sender — the Information Receiver of hoped-for insurance verification from the Payer. There is incorrect information in the Provider object, or possibly a missing PayerID.
Subscriber RequestThere is incorrect content in the Subscriber object. A nicely detailed and extensive list of possible errors arises from this category. A significant one involves Invalid /Missing Subscriber/Insured Name, which usually denotes the patient in the request does not have active insurance with the Payer.
The Out of network messages are in this category.
Subscriber Request ValidationThe request contains subscriber information that caused problems with processing it, such as incorrect dates, or in some cases the Payer requests more data.
Dependent RequestThere is incorrect or missing content for the dependent in the Eligibility request. Many of the same error types you see for subscriber information also see usage here.
Dependent Request ValidationThe request contains dependent information that caused problems with processing it, such as incorrect dates. In some cases the payer requests more data.

AAAError Message Examples

  1. This error example is a Request validation error, showing code T4 describing that the request is missing correct payer information whether it is the correct payer name or the correct payorId. Because the submitter (the Information Receiver) has authorization to do business with the payer, the message Resubmission Allowed signals that the provider can fix the problem and try again.
{ 
    "field": "AAA", 
  "code": "T4", 
  "description": "Payer Name or Identifier Missing", 
  "followupAction": "Resubmission Allowed", 
  "location": "Loop 2100A",
  "possibleResolutions": "Payer Name or Identifier Missing."
},
  1. This error reports that the correct Provider information is missing in the request. It is an error from the Information Receiver Request Validation AAA category (Consult Page 243 of the ASC X12 Consolidated 270/271 Implementation Guide).
{
  "field": "AAA",
  "code": "43",
  "description": "Invalid/Missing Provider Identification",
  "followupAction": "Resubmission Not Allowed",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's NPI most likely is not registered with the payer, or not registered correctly with the payer, and the provider must contact payer directly to correct, Emdeon can not do this for them, it is a PHI/HIPPA restriction"
},
{
  "field": "AAA",
  "code" : "04",
  "description": "Authorized Quantity Exceeded",
  "followupAction": "Please Correct and Resubmit",
 }
{
   "field": "AAA",
   "code": "35",
   "description": "Out of Network",
   "followupAction": "Do Not Resubmit; Inquiry Initiated to a Third Party",
   "location": "Loop 2100C",
   "possibleResolutions": "Provider is not in network provider for the subscriber's plan"
},
{
  "field": "AAA",
  "code": "42",
  "description": "Unable to Respond at Current Time",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100C",
  "possibleResolutions": "Is what we call the catch-all error.First place to start is look at PIRs to see if payer is having issues processing. If no PIR for payer call Command Center and have them check the system see if they are seeing trouble with the payer.Follow standard troubleshooting flow if no issue happening with payer."
},
{
  "field": "AAA",
  "code": "45",
  "description": "Invalid/Missing Provider Specialty",
  "followupAction": "Please Wait 30 Days and Resubmit",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's NPI not registered with the payer under the correct Specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA."
},
{
  "field": "AAA",
  "code": "47",
  "description": "Invalid/Missing Provider State",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's address doesn't match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA."
},
{
  "field": "AAA",
  "code": "48",
  "description": "Invalid/Missing Referring Provider Identification Number",
  "followupAction": "Do Not Resubmit; Inquiry Initiated to a Third Party",
  "location": "Loop 2100D",
  "possibleResolutions": "Referrals only: Referring provider's NPI is either not registered with the payer, provider must contact payer directly, or Enrollment with Emdeon is incorrect, contact enrollment department."
},
{
  "field": "AAA",
  "code": "49",
  "description": "Provider is Not Primary Care Physician",
  "followupAction": "Resubmission Not Allowed",
  "location": "Loop 2100D",
  "possibleResolutions": "Referrals only: Referring provider must be Primary Care Physician in some payer plans, insured must contact payer and set PCP in their system. Emdeon can not do this due to PHI/HIPPA guidelines."
},
{
  "field": "AAA",
  "code": "51",
  "description": "Provider Not on File",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Provider is not registered with the payer, provider must call payer directly to register their NPI"
}
{
  "field": "AAA",
  "code": "52",
  "description": "Service Dates Not Within Provider Plan Enrollment",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider was not registered in the insured's plan with the payer, on the DOS listed in transaction."
},
{
  "field": "AAA",
  "code": "57",
  "description": "Invalid/Missing Date(s) of Service",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100D",
  "possibleResolutions": "DOS is not within allowable time frame, or DOS is missing in the 270"
}
{
  "field": "AAA",
  "code": "63",
  "description": "Date of Service in Future",
  "followupAction": "Please Wait 30 Days and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Some Payers do not accept DOS in the future check payer instruction tables for specs per payer."
},
{
  "field": "AAA",
  "code": "72",
  "description": "Invalid/Missing Subscriber/Insured ID",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Subscriber member ID is incorrect in the request being sent."
},
{
  "field": "AAA",
  "code": "76",
  "description": "Duplicate Subscriber/Insured ID Number",
  "followupAction": "Resubmission Not Allowed",
  "location": "Loop 2100C",
  "possibleResolutions": "Duplicate member ID is found in the payer database."
},

AAAError Codes and Possible Resolutions

AAAError CodeReasonPossible Resolution
04Authorized Quantity ExceededBatches cannot contain more than 99 single transactions.
15Required application data missing
  • Payer search criteria is not met.
  • Problem at payer.
  • Search criteria set up incorrectly on Change Healthcare side.
  • 33Input ErrorsDuplicate transaction.
    35Out of NetworkProvider is not an in-network provider for the subscriber's plan.
    41Authorization/Access Restrictions
  • If it comes before the 2000A loop, it is most likely an enrollment issue with the vendor or provider's tax ID.
  • If it comes after the 2000A or after the 2000B loop, it is an enrollment issue.
  • Issue with payer assigned log in ID.
  • Incorrect/missing portal payer credentials.

  • 42Unable to Respond at Current Time
  • Payer processing issue.
  • Problem within 270 request causing payer to be unable to respond.
  • 43Invalid/Missing Provider Identification
  • Provider's NPI is not registered with the payer.
  • Provider's NPI not registered correctly with the payer.
  • Payer requires an agreement.
  • 44Invalid/Missing Provider NameProvider's NPI is registered with the incorrect name at the payer. Provider must contact the payer directly to have this issue fixed, due to PHI/HIPPA.
    45Invalid/Missing Provider SpecialtyProvider's NPI not registered with the payer under the correct Specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA.
    46Invalid/Missing Provider Phone NumberProvider's phone does not match what is registered with the payer or the NPPES system for this provider. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA.
    47Invalid/Missing Provider StateProvider's address does not match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA.
    48Invalid/Missing Referring Provider Identification Number
  • Referring provider's NPI is not registered with the payer plans.
  • Provider must contact payer directly.
  • Enrollment with Emdeon is incorrect, contact enrollment department.
  • 49Provider is Not Primary Care Physician
  • Provider must be PCP in some payer plans.
  • Insured must contact payer and set PCP in their system, CHC cannot do this due to PHI/HIPPA guidelines.
  • 50Provider Ineligible for InquiriesProvider is not registered for that service type with the payer, provider's has to contact payer directly.
    51Provider Not on FileProvider is not registered with the payer, provider must call payer directly to register their NPI.
    52Service Dates Not Within Provider Plan EnrollmentProvider was not registered in the insured's plan with the payer, on the Date-of-Service (DOS) listed in transaction.
    53Inquired Benefit Inconsistent with Provider TypeProvider submitting a transaction for specialty that they are not registered with the payer to perform.
    55Inappropriate Product/Service IDInvalid procedure code.
    56Inappropriate Date
  • Incorrect date.
  • Incorrect date format.
  • 57Invalid/Missing Date or Service
  • Date-0f-service (DOS) is not within allowable time frame.
  • DOS is not included in the 270.
  • DOS is in the future.
  • 58Invalid/Missing Date-of-Birth (DOB)
  • DOB is not included in 270.
  • DOB is incorrect in 270.
  • 59Invalid/Missing DOB
  • DOB is not included in 270.
  • DOB is incorrect in 270.
  • 60DOB Follows DOSDOS is before the DOB in which case, the transaction should be submitted with the mother's information.
    61Date of Death (DOD) Precedes DOSInsured died before DOS listed in the transaction, provider must correct and resubmit.
    62DOS Not Within Allowable Inquiry PeriodDOS is outside of the accepted time frame for for requests to be submitted for the payer.
    63DOS in the futureSome Payers do not accept DOS in the future check payer instruction tables for specs per payer.
    64Invalid/Missing Patient ID
  • Patient ID is missing and required by payer.
  • Patient ID is incorrect in the request and needs to be verified with a copy of insurance card.
  • 65Invalid/Missing Patient Name
  • Patient name is not included in the request (270).
  • Patient name is spelled differently in the payer database than the provider entered into the request (270)
  • .
    66Invalid/Missing Patient Gender Code
  • Invalid/missing gender type code.
  • Invalid/missing patient.
  • 67Patient Not Found
  • Patient is not in the payer's database.
  • Patient is not included in the Data File used for Hosting.
  • 68Duplicate Patient ID NumberThere is either a different patient with the same member ID in the payer's database or in the hosted data file.
    69Inconsistent with Patient's AgeWhen Diagnoses codes are inconsistent with patient's age.
    70Inconsistent with Patient's GenderProcedure codes are inconsistent with patient's gender.
    71Patient DOB Does Not Match That for the Patient on the DatabaseDOB sent in request does not match what is in the payer's database, the subscriber will need to contact the payer to have this changed.
    72Invalid/Missing Subscriber/Insured ID
  • Subscriber member ID is incorrect in the 270 request.
  • Request does not meet the payer requirements for subscriber ID.
  • 73Invalid/Missing Subscriber/Insured Name
  • Incorrect subscriber name submitted.
  • Subscriber name missing.
  • Subscriber name spelled incorrectly.
  • Request is not meeting payer requirements for subscriber name.
  • 74Invalid/Missing Subscriber/Insured Gender Code
  • Subscriber's gender code was not submitting.
  • An invalid character.
  • Incorrect gender code.
  • 75Subscriber/Insured Not Found
  • Subscriber was not found for a direct connect payer
  • Subscriber not found in payers.
  • 76Duplicate Subscriber/Insured ID NumberDuplicate member ID is found in the payer database.
    77Subscriber Found: Patient Not FoundSubscriber was found in payer's database but the dependent's information is not in the payer's database.
    79Invalid Participant IdentificationNPI in the 270 request is not on file with the payer.
    80No Response received - Transaction Terminated
  • Payer processing issue.
  • Transaction timed out.
  • Payer sent invalid 271 response.
  • T4Payer Name or Identifier Missing
  • Incorrect/invalid payer ID.
  • Payer processing issue.
  • AAAError follow-up action codes

    CodeMessage
    CPlease Correct and Resubmit
    NN Resubmission Not Allowed
    PPlease Resubmit Original Transaction
    RResubmission Allowed
    SDo Not Resubmit; Inquiry Initiated to a Third Party
    WPlease Wait 30 Days and Resubmit
    XPlease Wait 10 Days and Resubmit
    YDo Not Resubmit; We Will Hold Your Request and Respond Again Shortly